BACKGROUND: The World Health Organisation (WHO) estimates that 100-140 million girls and women have undergone female genital mutilation or cutting (FGM/C). FGM/C is an ancient cultural practice prevalent in 26 countries in Africa, the Middle East and Asia. With increased immigration, health professionals in high income countries including UK, Europe, North America and Australia care for women and girls with FGM/C. FGM/C is relevant to paediatric practice as it is usually performed in children, however, health professionals’ knowledge, clinical practice, and attitudes to FGM/C have not been systematically described. We aimed to conduct a systematic review of the literature to address this gap.

METHODS: The review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42015015540, http://www.crd.york.ac.uk/PROSPERO/ ). Articles published in English 2000-2014 which used quantitative methods were reviewed.

RESULTS: Of 159 unique articles, 18 met inclusion criteria. The methodological quality was poor – six studies met seven of the eight quality criteria. Study participants included mainly obstetricians, gynaecologists and midwives (15 studies). We found no papers that studied paediatricians specifically, but two papers reported on subgroups of paediatricians within a mixed sample of health professionals. The 18 articles covered 13 different countries: eight from Africa and 10 from high income countries. Most health professionals were aware of the practice of FGM/C, but few correctly identified the four FGM/C categories defined by WHO. Knowledge about FGM/C legislation varied: 25 % of professionals in a Sudanese study, 46 % of Belgian labour ward staff and 94 % of health professionals from the UK knew that FGM/C was illegal in their country. Health professionals from high income countries had cared for women or girls with FGM/C. The need to report children with FGM/C, or at risk of FGM/C, to child protection authorities was mentioned by only two studies.

CONCLUSION: Further research is needed to determine health professionals’ attitudes, knowledge and practice to support the development of educational materials and policy to raise awareness and to prevent this harmful practice.

Since its inception, it has lobbied for a confidential national reporting system.

There were two reasons for this: the first is that as a group of clinicians, we could not provide effective evidence-based care for women if we did not know how many women had been subject to this abhorrent procedure; the second is that we wanted to provide clinical education for midwives, nurses, health visitors and doctors so that the best care can be provided to women.

With the support of Baroness Rendell, who has been raising questions in the House of Lords for nearly two decades, we met with Jane Ellison MP. It was a real meeting of minds and it was clear that, from this meeting, we would finally make progress when she agreed that it was nigh on impossible for us to address a problem in the UK without knowing the true extent of it….

The Royal College of Obstetricians and Gynaecologists has revised its guideline on female genital mutilation to clarify healthcare professionals’ legal responsibilities, the requirements to notify cases, and the management of women who have undergone mutilation who are pregnant or giving birth.

The update comes after the first attempted UK prosecution of a doctor for female genital mutilation. Dhanuson Dharmasena, a trainee registrar in obstetrics and gynaecology at the Whittington Hospital in north London, was acquitted earlier this year...

Female circumcision is a custom which continues to be widespread in many parts of the word, yet very little is known about the practice by health care providers in the United States. Student health services in colleges and universities with large populations of international students need to be prepared to meet the health needs of this group of women. This paper discusses basic information about the practice of female circumcision. It summarizes data from a descriptive study conducted to identify specific needs and concerns of a group of 12 circumcised women who have used the western medical system while living in the United States. It also discusses the results of a follow-up study based on a questionnaire sent to 95 student health centers in the United States that had a foreign student population base of more than 500. Responses to the questionnaire identified the problems and concerns that student health providers encountered while caring for circumcised women. Suggestions for improved care are included from the perspective of both the client and the student health service personnel.

Female circumcision (clitoridectomy), a traditional practice in some Third World societies, is discussed, and related medical procedures are described. Medical and psychosexual implications for the patient are considered, and college health clinicians are encouraged to be prepared to see patients who have been subjected to the procedure and help these young women deal with attendant medical, emotional, and cultural issues. One female student’s experience at her college health service is described.

government should make the failure of professionals to report concerns a criminal offence unless reports rise substantially, a committee of MPs has said.

In a hard hitting report that denounces the practice as an “extreme form of child abuse,” the House of Commons home affairs committee called the UK’s failure to tackle FGM a “national scandal” and urged the adoption of a national action plan.

The report described the record of referrals of cases to social services by healthcare professionals as “extremely poor” and said many cannot even recognise the signs that a child is at risk. “It is unacceptable that those in a position with the most access to evidence of these crimes do nothing to help the victims and those at risk,” the MPs said…

A London GP who removed almost all of the labia minora of a patient during cosmetic surgery has been cleared of practising female genital mutilation by the Medical Practitioners Tribunal Service.

Sureshkumar Pandya performed labiaplasty in March 2012 on a 33 year old woman named only as Patient A, who complained that her labia were “ugly” and made her uncomfortable. He saw her again a week later and recorded that the wound was healing well.

But a week after that, Patient A went to see another GP, who recorded in her notes: “Patient upset …

Doctors are key to securing the UK’s first conviction for female genital mutilation, say campaigners.

Hives-Wood S.

EXTRACT

Doctors who find evidence of female genital mutilation (FGM) should treat it as a crime and report it to police, a coalition of health organisations has recommended.

The coalition said that a government funded awareness strategy was needed, similar to that launched in the 1990s to tackle HIV, to prevent the genital mutilation of young girls. Doctors and other health and care professionals should be held responsible for monitoring female genital mutilation and treating it as child abuse.

The increasing number of immigrants from African countries practicing female genital mutilation (FGM) has raised concern in Europe. Health care professionals have developed three main responses: (1) technical guidelines for clinical management; (2) codes of conduct on quality of care; and (3) specialised health services for medical and psychological care and counselling. Much remains to be done, however, to ensure adequate care in Europe: (1) medico-legal/ethical discussions; (2) development of protocols to assist in making informed decisions; and (3) development of guidelines on counselling, communication strategies, and referral procedures. All agencies working in the field of FGM should be interlinked at the national level, in which members of the affected communities should be included. At the European level, a coordinated approach between all agencies should be developed.